Acute Hand Injury in Surfing: A Case Report.

Hand injuries from surfing tend to be severe and require medical attention. Follow-up of a surfing injury is difficult because many patients are visiting and go home after treatment. We report a case of a surfing hand injury sustained abroad, which was treated upon the patient's return, allowing for follow-up. The mechanism of injury was traction and torsion from the surfboard leash while surfing. The patient was initially treated for nailbed injury but presented later back home after persistent pain, for which an unstable distal phalanx fracture in their right ring finger was found by x-ray. This was surgically reduced with K-wire insertion and nailbed repair. Postoperatively, the injured finger was kept in a splint, and the patient had physiotherapy. Pain was significantly reduced, and the patient regained sufficient function. Considering a fracture as a differential for finger injury caused by the surfboard leash may prevent management delays. Injury may be prevented through education and redesign of the surfboard leash.

[Sport Injuries to Wrist and Fingers].

INTRODUCTION: About one fifth of all sports accidents involve the hand. Many injuries can be diagnosed and treated easily. However, some of them such as fractures of the scaphoid or the hamate of the hamulus are difficult to detect with conventional radiographs and are often missed without a CT scan. Ligament injuries such as the skier's thumb must be recognized and treated properly, often surgically. There are also sport-specific injuries, such as the closed rupture of a flexor tendon pulley in climbers, which otherwise occur rarely and are little known. These topics, pitfalls and tricks will be discussed.

Stress Fractures of the Distal Phalanx in Skeletally Immature Sport Climbers.

Stress fractures in the distal phalanx of skeletally immature patients are rare and previously unreported clinical occurrences. We report on 2 adolescent sport climbers with such fractures of the dorsal metaphysis of the distal phalanx at the point where parts of the extensor tendon insert. A conservative treatment approach alone was sufficient in healing this fracture type in both patients after 12 wk. Clinicians should be informed of the existence of this rare clinical phenomenon and counsel patients that a conservative treatment approach may result in complete healing without the need for an invasive procedure.

A Finger in the Game: Sport-Specific Finger Strength Training and Onset of Injury.

INTRODUCTION: Strength training has proved to be an effective way to prevent injuries, but the evidence of the impact of strength training on finger injuries is lacking. A fingerboard is a sport-specific tool used by climbers for strength training of fingers. In this study, we searched for associations between fingerboard training and finger injuries in climbers with different lengths of climbing experience and levels of performance. METHODS: A web-based survey was used to collect information on self-perceived pain or injury in fingers (SPIIF) and regular fingerboard training (RFT). The survey was administered to the Finnish climbing community. Data were analyzed using contingency tables; chi-square was used to evaluate statistical significance. RESULTS: No significant correlations between SPIIF and RFT were found when analyzing all the participants (n=434) together. In climbers with 6 y or more in the sport, SPIIF was not common and RFT was negatively associated with SPIIF (χ2 [1, n=200]=4.57; P=0.03). In contrast to this, in male climbers who had been climbing for less than 6 y and had advanced to 7a level or higher (French lead/Font bouldering), SPIIF was common and RFT was positively associated with SPIIF (χ2 [1, n=75]=4.61; P=0.03). CONCLUSIONS: We suggest that doing RFT may prevent SPIIF in climbers with a long background in the sport as fingerboard training can help build stronger fingers and thereby stronger tendons and ligaments. Climbers with fewer years in the sport and less adaptation to the fingers should be cautious with their training loads and RFT to avoid finger injuries and pain.

Palmar Shift of the Proximal Interphalangeal Joint in Different Grip Positions as a Potential Risk Factor for Periphyseal Injuries in Adolescent Climbers.

INTRODUCTION: The aim of this study was to evaluate different grip positions as a contributing factor for primary periphyseal stress injuries of the finger phalanges in climbing. METHODS: Ultrasound imaging of the proximal interphalangeal joint was performed on 37 asymptomatic adolescent climbers. Longitudinal images were obtained of middle and ring fingers of both hands in different grip positions (open, half-open, and crimp), unloaded and loaded. The translation between the dorsal head of the proximal phalanx and the shaft of the middle phalanx was measured in an unloaded and loaded situation for all grip positions. The resulting difference was determined as the palmar shift. RESULTS: The mean age of the study population was 13 y. Results showed a palmar shift of 0.57 mm in a loaded crimp grip position compared to 0.13 mm in an open position and 0.20 mm in a half-open grip position. With a P value of <0.001, this shift was significantly higher in a crimp grip position compared to open or half-open grip positions. CONCLUSIONS: This leads to an increase in joint incongruity and much higher peak forces on the dorsal aspect of the epiphyseal-physeal-metaphyseal complex, which is particularly vulnerable during the adolescent growth spurt. Thus, climbing and training behavior should be adapted accordingly during this phase by avoiding the crimp grip position until epiphyseal fusion.

[Nail and fingertip injuries: a practical guide for general practitioners]. / Traumatismes de l'ongle et de l'extrémité digitale : guide pratique pour le médecin de premier recours.

Nail and fingertip injuries account for approximately 15 to 24% of hand injuries and are particularly frequent among young and active patients. Despite their prevalence they are often overlooked and considered as cosmetology. However, the nail unit involves complex anatomical structures that help to improve the sensitivity and fine motor skills of the fingers and protect the distal phalanx. If not treated correctly, these injuries can generate significant functional impairments. This article aims to present the most frequently encountered traumas, their anatomical and physiological involvement, and their management in the standard practice of the general practitioner.

Les traumatismes unguéaux et de l'extrémité des doigts représentent 15 à 24 % des lésions de la main et sont particulièrement fréquents chez les jeunes patients actifs. Malgré leur prévalence, ils sont souvent négligés et considérés comme de la cosmétologie. Or l'ongle et la partie distale du doigt comportent des structures anatomiques complexes qui participent à améliorer la sensibilité, la motricité fine et à protéger les phalanges distales. Les traumatismes de ces structures, s'ils ne sont pas pris en charge correctement, peuvent engendrer des séquelles fonctionnelles importantes. Cet article a pour but de présenter les traumatismes les plus fréquemment rencontrés, leur implication anatomique et physiologique ainsi que leur prise en charge dans la pratique courante de médecine de premier recours.

Prognostic Factors for Attempted Finger Replantation and Revascularisation after Traumatic Amputation: A 16-Year Retrospective Cohort Study.

Background: The aim of this study was to evaluate the impact of variant factors on finger replantation and revascularisation after traumatic amputation, which also included duty shift and the level of main operator. Methods: To determine the prognostic factors for the survival rate of finger replantation and revascularisation after traumatic finger amputation, we retrospectively reviewed the cases of finger replantation conducted from January 2001 to December 2017. Data collected consisted of the basic information of the patients, trauma-related factors, details of the operation and treatment outcomes. Descriptive statistics and data analysis was performed to assess outcomes. Results: In total, 150 patients with 198 replanted digits were enrolled in this study. The median age of the participants was 42.5 years, and 132 (88%) patients were men. The overall successful replantation rate was 86.4%. Seventy-three (36.9%) digits had Yamano type 1 injury; 110 (55.6%), Yamano type 2 injury and 15 (7.6%), Yamano type 3 injury. In total, 73 (36.9%) digits were completely amputated and 125 (63.1%) were not. Half of the replantation procedures (101, 51.0%) were performed during night shift (16:00-00:00), 69 (34.8%) during day shift (08:00-16:00) and 28 (14.1%) during graveyard shift (00:00-08:00). Multivariate logistic regression demonstrated that the trauma mechanism and type of amputation (complete vs. incomplete) significantly affect the survival rate of replantation. Conclusions: The trauma mechanism and type of amputation (complete vs. incomplete) significantly affect the survival rate of replantation. Other factors including duty shift and the level of operator did not reach statistically significance. Further studies must be conducted to validate the results of the current study. Level of Evidence: Level III (Prognostic).

Fingertip degloving injury coverage with homodactyle bipedicled dorsal island flap.

OBJECTIVES: To investigate the curative effect of repairing digital degloving with flaps from the bilateral dorsal branch of the proper digital artery of the same finger. MATERIAL AND METHODS: Twenty-three patients with fingertip degloving injury treated with flaps from the bilateral dorsal branch of the proper digital artery of the same finger in our hospital from February 2020 to March 2022 were retrospectively included. Active finger range of motion, cold intolerance, pain on visual analogue scale and patient satisfaction were evaluated. RESULTS: There were 3 cases of flap blister and 2 of vascular crisis after the operation, all of which healed after symptomatic treatment. All the other flaps and skin grafts survived. Follow-up ranged between 6 and 25 months (mean, 13.8 months). The skin flap was full in shape and soft in texture. Incidence of cold intolerance was low in the palmar flaps and dorsal flaps, and finger range of motion recovered well. The technique relieved pain, and patients were satisfied with the results. CONCLUSION: Flaps from the bilateral dorsal branch of the proper digital artery of the same finger were effective for repair of fingertip degloving. The technique easy to implement, and can repair large defects; the repaired finger shows good function and appearance.

Closed Traumatic Zone 2 Flexor Tendon Injury of the Long Finger - A Case Report.

Closed rupture of the flexor digitorum profundus (FDP) tendon causes loss of flexion at the distal interphalangeal joint. Following trauma, these are known to present as avulsion fractures (Jersey finger) commonly in ring fingers. Traumatic tendon ruptures at the other flexor zones are seldom noted and are often missed. In this report, we present a rare case of closed traumatic tendon rupture of the long finger FDP at zone 2. Though it was missed initially, was confirmed with Magnetic Resonance Imaging and underwent successful reconstruction using an ipsilateral palmaris longus graft. Level of Evidence: Level V (Therapeutic).

Treatment of Multiple Finger Laceration Caused by Green Onion Cutting Machines in South Korea.

Background: Finger injuries caused by green onion cutting machines in Korean kitchens have unique characteristics of an incomplete amputation in which multiple parallel soft tissues and blood vessels are injured in the same form. In this study, we aimed to describe unique finger injuries and to report the treatment outcomes and experiences of performing possible soft tissue reconstructions. Methods: This case series study included 65 patients (82 fingers) from December 2011 to December 2015. The mean age was 50.5 years. We retrospectively classified the presence of fractures and the degree of damage in patients. The injured area involvement level was categorised as distal, middle or proximal. The direction was categorised as sagittal, coronal, oblique or transverse. The treatment results were compared according to the amputation direction and injury area. Results: Of the 65 patients, 35 had a partial finger necrosis and needed additional surgeries. Finger reconstructions were performed through stump revision or local or free flap use. The survival rate was significantly lower in patients with fractures. As for the injury area, distal involvement led to 17 out of 57 patients displaying necrosis and all 5 patients showing the same in proximal involvement. Conclusions: Unique finger injuries caused by green onion cutting machines can easily be treated with simple sutures. Then prognosis is affected by the extent of injury and the presence of fractures. Reconstruction is necessary for finger necrosis owing to extensive blood vessel damage and limitations when making this selection. Level of Evidence: Level IV (Therapeutic).

Wrist, hand and finger injuries in Australian football: A prospective observational study of emergency department presentations.

OBJECTIVES: Investigate the characteristics of wrist, hand and finger (WHF) injuries in Australian footballers presenting to EDs and determine if injury profiles differed between females and males, and between children and adults. METHODS: In this prospective observational study that took place during an entire football season, patients attended 1 of 10 EDs in Victoria, Australia with a WHF injury sustained while playing Australian football. Data were extracted from patient medical records by trained researchers. Data included injury type (e.g. fracture), body part (e.g. metacarpal) and mechanism of injury. Males versus females, and children versus adults were compared using chi-squared tests or Fisher's exact tests. RESULTS: In total, 528 patients had a WHF injury, of which 105 (19.9%) were female and 308 (59.2%) were children. Fractures and sprains were the most common injury types (45.3% and 38.6%, respectively). Fingers were more often injured than wrists or hands (62.5%, 23.5% and 15.0%, respectively). Ball contact was the most common mechanism of injury (38.1% of injuries). Females were more likely than males to (i) have a sprain/strain injury, (ii) injure a finger (rather than wrist or hand) and (iii) injure themselves through ball contact. Children were more likely to injure their wrists, have a sprain/strain injury, or be injured falling to the ground. Adults were more likely to dislocate a joint or injure their hands. CONCLUSIONS: Differences in injury type, location and mechanism between females and males, and children and adults, suggest an opportunity for customised injury prevention and management strategies by sex and age.

Delayed Presentation of a Flexor Digitorum Profundus Avulsion Injury: A Case Report.

Avulsion of the flexor digitorum profundus (FDP) tendon is a relatively common injury in athletes. Also known as "jersey finger," it can also occur in nonathletes, and is often not initially diagnosed. Early diagnosis and repair are essential to regaining optimum return of function. We report a case of a 37-year-old woman who was seen six weeks following an undiagnosed FDP avulsion injury. Due to finger stiffness and the delayed diagnosis, she was treated with occupational therapy to maximize finger range of motion. The anatomy, classification, diagnosis, and treatment options for FDP avulsion injuries are discussed. The goal of this paper is to increase awareness for this injury, resulting in early diagnosis and prompt treatment.

The Epidemiology of Hand and Finger Lacerations in United States Emergency Departments.

BACKGROUND: Hand and finger lacerations presenting to U.S. emergency departments (EDs) are common, although the burden of these injuries is not well understood. OBJECTIVE: Our aim is to describe the epidemiology and causes of hand and finger lacerations in U.S. EDs. METHODS: This National Electronic Injury Surveillance System database review investigates hand and finger lacerations presenting to EDs in the United States from 2015 to 2019. RESULTS: Annually, hand and finger lacerations account for 243,844 and 587,451 ED visits, respectively. Affected patients are frequently White (70.5%), male (63.4%), and aged 18 through 44 years (46.3%). The top three products linked to hand and finger lacerations are knives (30.5%), metal containers (4.2%), and drinkware (3.8%), and men are less likely to have injuries from these products than women, especially knives (odds ratio 0.76; 95% confidence interval 0.60-0.96; p < 0.02). Although a minority of hand and finger lacerations involve alcohol (1.2%), men have greater rates of alcohol involvement than women (χ21 = 11.7; p < 0.001). Lacerations frequently occur in the home (61.3%). Many patients (44.2%) present to very large hospitals, and nearly one-half of patients younger than 5 years and one-third of patients aged 5 through 17 years present to pediatric hospitals. Most patients (97.4%) are treated and released without admission and 0.2% are transferred to another hospital. Patients with alcohol, drug, or medication involvement are more likely to leave against medical advice, be admitted, or held for observation (p < 0.001). CONCLUSIONS: Hand and finger lacerations result in a significant number of ED visits. A better understanding of injury trends and presentations can guide injury prevention in manufacturing, education, and public health.

Irreducible Phalangeal Fractures Due to Incarceration into the Extensor Tendon Apparatus - A Report of Two Patients.

Irreducible phalangeal fractures are uncommon, and if neglected can cause fracture non-union or functional deficits of the affected digit. We present two patients with irreducible phalangeal fractures - one in a child with a juxta-epiphyseal middle phalanx fracture incarcerated into the triangular ligament of the extensor apparatus and another in an adult following incarceration of a fractured proximal phalanx into the common intrinsic tendon on the radial side. Both required open reduction to extricate the incarcerated fracture ends, achieving good union and excellent functional outcomes. Level of Evidence: Level V (Therapeutic).

An overview of mallet finger injuries.

Mallet finger describes a fingertip deformity where the distal interphalangeal joint (DIPJ) of the affected digit is held in flexion, unable to extend the distal phalanx actively. The deformity is typically a consequence of traumatic disruption to the terminal extensor tendon at its insertion at the proximal portion of the distal phalanx or slightly proximally at the level of the DIPJ. Patients typically present with a history describing the event of injury with a typical mallet deformity. Common mechanisms include sport activities causing a direct blow to the finger, low energy trauma while performing simple tasks such as pulling up socks or crush injuries from getting the finger trapped in a door. The DIPJ can be passively extended, but this extension of the joint cannot be maintained once the passive extension is stopped. The Doyle classification can be used to categorise and dictate treatment. The extensor lag associated with the deformity does not improve spontaneously without treatment. Inappropriate management can lead to chronic functional loss and stiffness of the finger. The majority of closed mallet splints are Doyle type I, which can be managed non-surgically with external splints, worn full-time to keep the fingertip straight until the tendon injury or fracture heals. Surgical techniques is considered for other types of mallet injuries. Techniques used include closed reduction and Kirschner wire fixation, open reduction and internal fixation, reconstruction of the terminal extensor tendon and correction of swan neck deformity.

Case series of: Iatrogenic digital compression ischaemic injury in the emergency department.

This brief report is a retrospective review of three cases of iatrogenic digital ischemia and clinical outcome at six months. Hand injuries are one of the most common injuries that occur in the working population. Iatrogenic digital ischemia is a rare condition that can be avoided by proper wound management. After the correct initial treatment is provided, it is important to apply the wound dressing correctly to avoid iatrogenic trauma or ischemia. Currently, there is no consensus regarding the best treatment for these injuries. Our aim is to remind clinicians of this rare condition, and to highlight prevention and treatment strategies.

Longer Tendon-Bone Distances of the A2 and A4 Annular Pulleys in Experienced High-Level Sport Climbers: Injury or Adaptation?

INTRODUCTION: Experienced high-level climbers are subject to a number of bone and soft tissue changes over the years and are also among the most exposed to pulley injuries. One of the main consequences of pulley rupture is the separation of the flexor tendons from the subjacent phalanges, also known as bowstringing. The purpose of this study was to determine whether this population has asymptomatic bowstringing of the A2 and/or A4 pulleys as determined by tendon-bone distance (TBD) values when compared to nonclimbers. METHODS: High-resolution ultrasound TBD measurements in active forced flexion were made for the A2 and A4 pulley of the ring finger bilaterally. Participants were 21 asymptomatic sport climbers who had 21 consecutive years of climbing at a level above 9.66 in the International Mountaineering and Climbing Federation difficulty metric scale. Control subjects were 21 age-matched nonclimbers. RESULTS: A significantly longer TBD-25% (0.3 mm) and 35% (0.4 mm) for the A2 and A4 pulleys, respectively-was found in the experienced climbers group (experienced climbers group: A2 1.6±0.5 mm and A4 1.6±0.4 mm; nonclimbers group: A2 1.2±0.1 mm and A4 1.2±0.2 mm). CONCLUSIONS: Our results suggest that bowstringing of A2 and A4 pulleys occurs in asymptomatic experienced high-level climbers, which could be interpreted as either an adaptive mechanism to workloads endured over years of climbing or a consequence of underdiagnosed pulley ruptures.